Promoting lung cancer screening of high-risk patients by primary care providers

• Published in: Cancer 2023-11, Vol.129 (22), p.3574-3581
• Main Authors: Colamonici, Marco, Khouzam, Nader, Dell, Catherine, Auge-Bronersky, Kristin, Pacheco, Esther, Rubinstein, Israel, Recht, Bradley
• Format: Article
• Language: English
• Subjects: Cancer screening; Computed tomography; Decision making; Health care; Lag time; Lung cancer; Medical screening; Minority & ethnic groups; Patients; Primary care; Public health; Quality control; Social factors; Socioeconomic factors; Socioeconomics
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.34955

Lung cancer screening (LCS) with low-dose computed tomography (LDCT) of the chest of eligible patients remains low. Accordingly, augmentation of appropriate LCS referrals by primary care providers (PCPs) was sought. The quality improvement (QI) project was performed between April 2021 and June 2022. It incorporated patient education, shared decision-making (SDM) with PCPs, and tracking of initial LDCT completion. In each case, lag time (LT) to LCS and pack-years (PYs) were calculated from initial LCS eligibility. The cohort's scores were compared to national scores. Patient zip codes were used to create a geographic map of our cohort for comparison with public health data. An immediate and sustained increase in weekly LCS referrals from PCPs was recorded. Of 337 initial referrals, 95% were men, consisting of 66.2% Black, 28.4% White, and 5.4% other. Mean PY was less for minorities (45.3 vs. 37.3 years; p = .0002) but mean LT was greater for Whites (7.9 vs. 6.2 years; p = .03). Twenty-five percent of veterans failed to report to their scheduled screening, and two declined referrals. Notably, most no-show patients lived in transit deserts. Furthermore, Lung-RADS scores 4B/4X were more than double the expected prevalence (p = .008). The PCPs in this study successfully augmented LCS referrals. A substantial proportion of these patients were no-shows, and our data suggest complex racial and socioeconomic factors as contributing variables. In addition, a higher-than-expected number of initial Lung-RADS scores 4B/4X were reported. A large, multisite QI project is warranted to address overcoming potential transportation barriers in high-risk patient populations.